Is the patient with frequent recurrent episodes of apparent GAS pharyngitis likely to be a carrier of pharyngeal GAS?
Clinicians should consider the possibility that some patients with frequent recurrent episodes of GAS pharyngitis may be chronic carriers of GAS and may be experiencing frequent viral infections. Since GAS carriers are unlikely to spread or cause GAS pharyngitis in close contacts, identification of GAS carriers and treatment with the goal of eradication of GAS is not indicated. During winter and spring, as many as 20% of asymptomatic school-age children may be GAS carriers. Tonsillectomy is not recommended solely to reduce GAS pharyngitis episodes.
The bottom line
GAS pharyngitis should be diagnosed with RADTs or throat culture. Treatment options for GAS pharyngitis should start with narrow spectrum beta-lactams, with once-daily amoxicillin now recommended as a treatment option.
Shulman et al. "Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America" (Clin. Infect. Dis. 2012 [doi: 10.1093/cid/cis629]).
Dr. Skolnik is an associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Guthrie is a third-year resident in the hospital’s family medicine program.